Rehabilitation exercises after breast cancer treatment

Exercise is an important part of breast cancer treatment and recovery. Exercising the arm and shoulder after breast cancer surgery helps:

improve muscle tone

regain and maintain movement and mobility in the arm and shoulder

regain the ability to do daily activities

lessen side effects of surgery, such as pain, joint stiffness and swelling

improve well-being

Rehabilitation exercises are also important after radiation therapy because this type of breast cancer treatment can continue to affect the arm and shoulder for several months. Exercises can help the arm stay flexible. It is beneficial to continue doing exercises for 2–3 months after finishing radiation treatment.

Every woman is different and heals at her own pace. Some exercises, such as those that increase arm and shoulder movement, can be done soon – often a few days – after surgery. When the doctor gives the go-ahead, other normal activities can be started again.

Take slow, deep breaths when doing each exercise. Deep breathing helps fill the lungs completely and can also improve relaxation. Breathe in as much air as possible while trying to expand the chest and stomach like a balloon. Relax and breathe out slowly and completely.

Do the exercises until you feel a gentle stretch, but not to the point of pain.

Begin doing exercises and daily activities slowly and gently.

Do not over-exercise.

Increased pain, discomfort and swelling are often signs of over-exercise.

Gradually increase the pace and level of activity. Aim to restore pre-surgery function in the hand and arm.

Prop up the arm with a pillow during or at the end of the day to help reduce swelling after surgery.

Report unexplained pain or swelling in the hand or arm to your doctor or physiotherapist.

Lymphedema is swelling that can occur when lymph nodes are surgically removed. Lymph nodes normally act as filters, but if they can’t do their job properly lymph fluid can build up in the hand or arm.

The time frames mentioned below are only suggested guidelines. Always check with the doctor or physiotherapist before beginning to exercise. They will usually recommend when to start exercising and which exercises to do. The type of exercises that may be done will depend on the type of surgery performed. Exercise instructions can vary with the doctor, physiotherapist or hospital.

Typically, gentle range-of-motion exercises can be done the first 3–10 days after surgery or while the drain is still in place. Try to use the affected arm (the one on the same side as surgery) for light daily activities, such as eating, washing and combing your hair. Repeat these exercises 3–4 times a day. Do not make any sudden movements until the incision has healed and the drain has been removed.

If surgery irritates nerve endings, there can be some soreness, numbness, tingling or a burning feeling on the back of the arm or the chest wall. These feelings may increase a few weeks after surgery, but you should try to keep doing the exercises unless there is increased swelling or tenderness. If you have these symptoms, tell your doctor. Sometimes gentle rubbing or stroking the area with a hand or a soft cloth can help make it feel better.

Pump it up

This exercise helps reduce swelling after surgery by using the muscles as a pump to improve the circulation in the affected arm (on the same side as the surgery). This can be done lying or sitting.

Lie on the unaffected side with the affected arm straight out in front of you, above the level of the heart (use pillows if needed). Alternatively, sit in a chair with good back support with the affected arm supported by pillows.

Slowly open and close the hand. Repeat 15–25 times.

Slowly bend and straighten the elbow. Repeat 15–25 times.

Shoulder shrugs and circles

This exercise can be done sitting or standing.

Lift both shoulders up toward the ears. Hold for 5–10 seconds, then slowly drop them down and relax. Repeat 5–10 times.

Gently rotate both shoulders forward and up, and then slowly back and down, making a circle. Switch directions. Repeat 5–10 times in each direction.

Arm lifts

This exercise can be done sitting or standing.

Clasp hands together in front of the chest. Extend the elbows so your arms are out in front of you, but your elbows are not locked.

Slowly lift the arms upward until a gentle stretch is felt. Hold for 1–2 seconds and then slowly return to the start position.

Repeat 5–10 times.

Shoulder blade squeeze

This exercise helps improve posture and movement in the shoulder. It can be done sitting, without resting against the back of the chair, or standing.

Place arms at your sides with the elbows bent.

Gently squeeze the shoulder blades together. Keep shoulders level and take care not to lift up or shrug the shoulders. Hold for 5–10 seconds. Relax and return to the start position.

It is important to start working on getting back full use of the shoulder as soon as possible. These exercises can be started as soon as the doctor or physiotherapist gives the go-ahead. Most women can start doing them about 3–6 weeks after surgery and after the drain is removed.

Do not lift anything heavier than about 5 kg (10 lbs) during this stage.

Wand exercise (3 positions)

This exercise helps improve the forward movement of the shoulder. You will need a “wand”, such as a broom handle, stick or cane, to do this exercise. There should not be any pain or pinching during these exercises – stop the movement if there is.

Position 1

Lie on your back with knees bent. Hold the wand in both hands (palms facing down), with hands shoulder width apart and elbows bent.

Straighten your arms and lift the wand over the head until you feel the stretch. The unaffected arm helps lift the wand. Hold for 1–2 seconds. Lower arms.

Repeat 5–10 times.

Position 2

Repeat with palms still facing down, but with hands slightly wider apart than the hips or shoulders.

Position 3

Repeat with palms facing up (undergrip) and the hands hip width apart.

Winging it

This exercise helps improve movement in the front of the chest and shoulder. It may take several weeks of regular exercise before you can get the elbows close to the floor. If there is pain or pinching in the shoulder, place a small pillow behind the head, above the affected shoulder.

Lie on the back with knees bent. Clasp hands behind the neck with elbows pointed up to the ceiling. (If putting hands behind the neck is too uncomfortable, place fingers on the forehead with palms facing up.)

Move elbows apart and down toward the floor. Hold for 1–2 seconds.

Repeat 5–10 times.

Good posture

This exercise helps improve posture and movement in the shoulder. It can be helpful to use a mirror to check your movements. It can be done sitting, without resting against the back of the chair, or standing.

Arms should be down at each side with elbows straight and palms facing the body.

Open the chest, gently squeeze the shoulder blades together and rotate thumbs so that the palms face forward. Hold for 5–10 seconds. Relax and return to the start position.

Repeat 5–10 times.

Wall climbing

This exercise helps increase shoulder movement. Try to reach a little higher up on the wall each day.

Stand facing the wall, about 5 cm (2 inches) away. Place both hands on the wall at shoulder level.

Use the fingers to climb up, or slide hands up, the wall until you feel the stretch.

Return to start position.

Repeat 5–10 times.

Snow angels

This can be done lying on the floor or on a bed.

Lie on back and extend arms out at the sides.

Move arms up to the head and down to the thighs and repeat (like making an angel in the snow).

More advanced exercises

Once there is good movement in the shoulder, you can try more advanced stretches. By the end of this stage, there should be full movement of the affected arm and shoulder. Continue doing all of the exercises until both arms are equally strong and move easily. This may take 2–3 months.

Do not lift anything heavier than about 5 kg (10 lbs) during this stage.

Side bends

This exercise helps improve movement on both sides of the body.

Sit in a chair and clasp hands together on the lap.

Slowly lift arms over the head, keeping elbows bent slightly.

When arms are above the head, bend at the waist and move the body to the right. Hold 1–2 seconds.

Return to the centre, and then bend to the left. Hold for 1–2 seconds.

Repeat 5–10 times.

Doorway stretch

This exercise helps increase shoulder movement.

Stand in a doorway and place each hand lightly on either side of the doorframe.

Exercise during this stage (beginning about 6 weeks after surgery) includes gradually introducing strengthening and general conditioning exercises. Day-to-day household and recreational activities can be introduced gradually.

Talk to the doctor or healthcare team before starting a specific strengthening program or trying aerobic exercise (exercise that gets the heart and lungs working hard). Check whether there are any special precautions that you need to take. Report any pain, shoulder tightness or swelling in the affected hand or arm.

Strengthening

Slowly getting back to household chores, gardening or yard work are some of the ways a person can continue to build their strength after breast cancer surgery.

About 4–6 weeks after surgery, women can usually start strengthening exercises with light weights (500 g to 1 kg or 1–2 lbs).

An unopened soup can or a plastic bottle filled with water can be used instead of free weights (dumbbells).

Check with the doctor or physiotherapist to decide what weight is best. They can also suggest suitable strengthening exercises for the upper body.

General conditioning

Regular aerobic exercise will improve a person’s general physical condition. It can help with recovery and has many health benefits. Aerobic exercise can help:

improve cardiovascular fitness, which is how well the heart, lungs and blood vessels deliver oxygen to the muscles